Toenail Fungus

Onychomycosis: Toenail Fungus

The medical term for toenail fungus is "onychomycosis," pronounced on * EE * ko * my * KO * sis. “Onycho” means pertaining to the nails and “mycosis” refers to a disease caused by a fungus. The fungus causes the nails to become thickened and yellow. Sometimes they appear white and splotchy, and sometimes yellowish-brown. Six to 10 million Americans have toenail fungus, although estimates are as high as 40 million.

The nails can curve in at the sides and thicken substantially at the center. The thickening can be seen in the picture above, along with the brittleness. Many times the nail will peel off layers, chip or break, leaving jagged edges as can be seen here. The pictures shown here are more severe cases of toenail fungus. Milder cases typically start with splotchy white patches or mild discoloring towards the tip of the nail.

The most commonly affected nail is the big toenail. But, any of the nails can be affected. The big toenail and the 5th toenail can be the first two nails affected. This is believed to be caused by rub and irritation from the shoes on these toes, causing some breaks in and around the nail, leaving these nails more susceptable to fungus infection.

Many times the nails can be uncomfortable, cause pain or result in ingrown toenails. The thickness from the fungus can cause pressure on the toe, resulting in pain or inflammation. Diabetics, and those with depressed immune systems, have a higher risk of developing toenail fungus and about a quarter of all diabetics have toenail fungus. Others with an increased risk of developing toenail fungus are the elderly, athletes and individuals with sweaty feet. The risk of developing toenail fungus increases with age.

Athletes have a higher risk because of more wear in occlusive shoes combined with repeated nail trauma. This is especially true for hikers, runners, backpackers, soccer, basketball and tennis players. Fungus likes to grow in moist, warm areas. This increases the chance of infection for those with excess sweating of their feet, also known as hyperhidrosis.

Treatments

Prescription Oral Medications

There are many treatments for toenail fungus and they range from oral antifungal medications to over the counter treatments. The oral medications are the most effective, but have side effects, are costly and need to be taken orally for three months. Lamisil® (terbinifine) is the most popular and effective medication. Although rare, severe liver damage has occured in patients with preexisting liver conditions taking oral antifungal medications. Terbinifine, the generic and a much more affordable version of Lamisil®, is now available. Research on terbinifine and fungal toenails.

Prescription Topicals

There are prescription topical medications which are more effective than the non-prescription medications. Topical therapy needs to be used daily for 6-9 months. Unfortunately, some of these are quite costly. The newest Penlac® nail laquer is a prescription medication which is applied like a nail polish. Penlac® has been shown to be safe and effective in the treatment of nail fungus. Ciclopirox, the generic version of Penlac is available and although it's much more affordable, a course of therapy may still cost $100-$200, depending on how many nails need to be treated. In the images above, the images showing only the partial nail affected and little thickening will have the greatest response to topical therapty. Research on Penlac®, diabetes and toenail fungus. New study on Ciclopirox and toenail fungus. Study in the Journal of Foot and Ankle Surgery on Ciclopirox and toenail fungus.

Laser Treatment

Laser treatment of toenail fungus is currently available and being further evaluated for safety and efficacy. The laser works by killing the pathogens responsible for the fungus infection, allowing the nail to grow back clear and fungus free. More on laser treatment for toenail fungus.

Over the Counter Treatments

There are many OTC (Over The Counter) products which can be purchased online or at the drug store. A few include Tineacide®, which combines lavender oil and tea tree oil (research on tea tree oil and fungus), Lamisil® topical nail treatment (research on topical terbinifine), Dr. Scholl’s® Nail Management Kit, Nonyx® Nail gel and Restore® which is great medication for adjunct treatment of toenail fungus. Some home remedies that can be used include melaleuca oil (tea tree oil), bleach, grapeseed extract, and Vics VapoRub®. Vics tends to decrease the thickness of the nails and will sometimes contribute to peeling off of layers of the nail. Most topicals, prescription medications, OTCs and home remedies, tend to have similar effectiveness. One key is to purchase a product that is a gel, solution, laquer or spray. Creams tend to not be as effective on the nails. Roughen up the nail surface with a file before application for better penetration. Use treatment daily and plan on going through therapy for 6-8 months.

Prevention

Make sure you take steps to prevent the fungus from worsening, spreading and re-infecting. Follow these steps:

Place an anti-fungal powder or spray in the shoes every other day.

Rotate your shoes often and keep them in a cool dry place.

Change your insoles frequently. Make sure they dry out between use.

Use an antiperspirant spray if your feet sweat excessively.

Wash your shower mat regularly in hot water.

Bleach out the shower on a weekly basis.

Avoid ill-fitting shoes as they can lead to jamming at the toes.

Wear sandals in the locker room, if you belong to a gym or health club.

Disclaimer: The advice on this website is not intended to substitute for a visit to your health care provider. We will not be held liable for any diagnosis made or treatment recommended. Consult your doctor if you feel you have a medical problem.